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CEREBRO-SPINAL FEVER

partisan) and discontent were aroused by the action of the Postmaster-General.

So far as the foreign language press was concerned there were about 750 newspapers in the 14 chief language groups with whose attitude the Government was chiefly concerned. Most of these regularly published the official news from Washington concerning war activities and purposes. The President was empowered under the Trading with the Enemy Act (Oct. 6 1917), to require that translations of political views and comment touching the United States or any other nation engaged in the war should be filed with the post-office officials at the mailing point in the case of all foreign language publications. Exemption from this rule by special permit was allowed and freely granted. The Post Office Department was designated by executive order as re- sponsible for the enforcement of these measures. In the same Act a very inclusive section gave the President complete power to control any form of communication to be delivered directly or indirectly to any .enemy or ally of enemy, or communications of any sort between the United States and any foreign country. By executive order of Oct. 12 the enforcement of this was put in the hands of a Censorship Board composed of the Secretaries of War and the Navy, the Postmaster-General, the chairman of the War Trade Board and the chairman of the Committee on Public Information. This body made the necessary regulations and by Dec. n 1917 had gathered a large staff at the necessary ports to enforce them. The regulations in no way modified the voluntary censorship exercised by the Press over itself.

About 6,000 out of 4,000,000 " alien enemies " were interned or put under restraint. In all, 1,532 persons were arrested under the Espionage Act.; about 75 more for threats against the President or for sabotage. There were 908 indictments for conspiracy. Acquittals and cases pending reduced the number of those actually convicted under the Espionage Act to about 600. The best-known case was that of Eugene V. Debs, former Socialist candidate for president, who was sentenced to 10 years in a Federal prison for a speech opposing the war and denouncing war as the work of capital. Others were the suppression of The Masses, a radical monthly, the cases of Abrams, Goldstein, Kate O'Hare, Berger, Rose Pastor Stokes, and the I.W.W. cases (Hay wood and 92 others).

Beyond the realm of Federal action were the state laws, drastic in some cases, and the executive orders of some zealous governors and state defence councils who saw danger in speaking foreign languages in public or over the telephone, or teaching German in the schools, or using certain text-books. There was sometimes a lack of discrimination between the parties essentially loyal, representing agrarian or labour discontent, and those of their leaders whose purposes and sentiments were doubtful. There was also the sort of unofficial censorship, undefined by law but real, which communities exercised against those who had been pro-German or who were now less rea ly than their neighbours thought fitting to subscribe for loans and the Red Cross, and to observe food regulations.

On the whole, however, it is doubtful if all these legal and extra-legal activities in a nation of 100,000,000 were serious enough to justify any general condemnation of war legislation, the courts, and the nation. The quick reaction and sharp criticism of unfortunate acts and decisions indicated that free speech and free press were still basic ideals in the United States.

REFERENCES : Official Bulletin (for executive orders) ; annual reports of the Attorney-General, Postmaster-General, etc.; Willoughby, Government Organization in War Time and After (1919); Creel, How We Advertised America (1920). Chafee's Freedom of Speech (1920) is a full and critical account with extensive bibliography. See especially J. L. O'Brian, " Civil Liberty in War Time " in Proceedings of New York State Bar Association, Jan. 1919. (G. S. F.)


CEREBRO-SPINAL FEVER (see 18.130). Although serious outbreaks of cerebro-spinal fever had occurred in Belfast in 1907, and in Glasgow and Edinburgh in 1906 and 1907, and although the deaths from cerebro-spinal fever in Scotland in 1907 reached 1,087, yet no considerable outbreak of the disease occurred in England or Wales until the first winter of the World War.

Cerebro-spinal fever had been made compulsorily notifiable in England in 1912, and in that year, in 1913, and in 1914, approxi- mately 300 cases were notified in England and Wales each year.

In 1915 the disease increased more than elevenfold, there being 2,343 civilian and 1,136 military cases. In Feb. 1915 the out- break indeed assumed very menacing proportions, and in a single week 228 cases were notified. Considerable alarm was aroused as the mortality was exceedingly high, and the serum treatment which had been so successful in the New York and Belfast epidemics appeared at this time to have little effect upon the mortality rate. Special investigations were therefore commenced by the responsible authorities (especially by the army with the assistance of the Medical Research Committee), which were continued during the war, and added greatly to the knowledge of the bacteriology and epidemiology of the disease.

Diminishing somewhat in 1916 the disease broke out with fresh vigour in 1917, military and civil cases being now about equal in numbers.

Aetiologically, there can be little doubt that the outbreak in England which followed the birth of the new armies was prin- cipally due to the overcrowding of young recruits in depots, camps, and billets. It is also probable, although this has been warmly controverted, that fresh and highly virulent strains of the meningococcus were brought to England by the Canadian con- tingents arriving in the late autumn of 1914 after having had several cases of cerebro-spinal fever in their home camps before embarkation and during the voyage east on their crowded trans- ports, and a sharp outbreak on arrival on Salisbury Plain several weeks before British troops were affected. These virulent Can- adian strains u.ay have aggravated the outbreak.

At Portsmouth, for example, the disease began on Jan. 15 1915, at Eastney barracks among men who came in contact with a Canadian football team which visited there on Jan. 9, and the first case of the disease at Caterham depot occurred in a man who travelled up from Scotland by night with three Canadian soldiers in the same compartment.

The aetiology of cerebro-spinal fever is peculiarly instructive from the fact that, in at least 95 % of all cases, the disease results not from infection derived from another patient suffering from the disease but from infection derived from an apparently healthy carrier, that is a person who harbours the meningococcus in his nasopharyngeal secre- tion without contracting the disease, and who is usually unaware of having ever been in contact with a patient suffering from the disease. Infection is most often transmitted in sleeping quarters.

Carriers are of two kinds: temporary carriers who harbour the meningococcus for only two or three weeks and who then become free spontaneously; and chronic carriers who harbour the germ for many months and even years.

Cleminson has shown that almost all chronic carriers have marked nasopharyngeal defects, the commonest type being that in which there is an obstinate mucous contact between a deflected and thick- ened nasal septum and the middle turbinate.

Chronic carriers are responsible for carrying on the disease from epidemic to epidemic and also for the sporadic cases which occur between epidemic times. Recovered patients are often chronic carriers, the meningococcus having been recovered after two years from the nasopharyngeal secretion in several instances.

In ordinary times the population probably contains some 2 % of carriers, but at the height of an epidemic in a crowded community, such as that on a ship or in a crowded depot, the carrier-rate may rise to 75 %, the vast majority of the carriers being temporary.

At the outbreak of war the necessity for rapidly raising enormous forces at once led to very serious overcrowding of the available bar- racks and depots, and the hastily erected camps and hutments were overcrowded as soon as they were erected. Military necessity was urgent and imperative.

In Jan. 1915, all the known requisite factors for an outbreak of cerebro-spinal fever were present : severe overcrowding, cold weather, and a population rendered susceptible by youth, by the fatigue of rapid training, by nostalgia, and by entry into a new method of life.

Recruits have always shared with infants a peculiar susceptibility to cerebro-spinal fever. The armies in the field despite far greater hardship suffered much less than the recruits training at home. The incidence of cerebro-spinal fever in the U. S. training camps fol- lowing their entry into the war was ^5 times as great as that in cor- responding male age groups in civil life.

Overcrowding has at least a threefold importance as a factor in the production of cerebro-spinal fever epidemics:

First, the atmosphere of an overcrowded and ill-ventilated room or hut, by lowering the individual resistance, tends to favour the